Reforms in health administration- a crying need

Dr. VK Bahuguna

(The writer is Retired civil servant)
To make India a country of 130 billion people a happy and contented nation it will require access to a robust health, education and employment/industrial infrastructure. The another element which is very vital in today's scenario is the state of our environment and stability of life sustaining natural resources like water, clean air and soil. Prime Minister Narendra Modi's few pro poor initiative like Prime Ministers like Pradhan Mantri Jan Arogya Yojna better known as Anshuman Bharat, Ujjawala Yojna for providing electricity and individual toilets under Swatch Bharat Mission made a lasting pro government impact on the minds of poor families in both the urban and rural areas before the 2019 general elections and the results was he returned with a thumping majority. 

While speaking on the first anniversary of Ayushman Bharat on 1st October the Prime Minister also flagged it as an employment generation venture for the next five years as it will create around 11 lakh jobs for the youth. The government endeavor is to make it the best health care example in the world with the registration of 46 lakh people in the scheme and out of this around 50,000 people have taken the benefits of the scheme outside their home district. The scheme is based on two facets. The first is to bring more than 10 crore poor and vulnerable families in its ambit by providing 5 lakh per family per year for secondary and tertiary hospitalization. Secondly, the government is going to upgrade 1.5 lakh primary health centers by the year 2022 so that needy can get comprehensive and quality health care based on equality and affordability. 

The intention of the governments are only to be applauded as it was very essential to take care of the health of needy and poor in a welfare state. The success of any venture depend upon the role played by the bureaucracy and honesty of private hospitals and benefit seekers. In the past many such welfare schemes were ruined by the corruption and the best example is the deep rooted corruption that unfolded in almost all states in the National Health Mission. A huge amount of money was looted by the medical bureaucracy all over the country. 

This writer has recently experienced the complete collapse of health and sanitary infrastructure in Uttarakhand due to the arrogance and lackadaisical attitude of the government officers and public representatives. The problem is of systemic failure, first the bureaucratic guidelines run counter to the objectives of the scheme and flung the patient in red tapism and; second the insensitivities and honesty of purpose among the Doctors and their bosses including the officers and Ministers sitting in state capitals. Let us discuss a small case of an individuals who was about to die but was saved because of the intervention of this writer who was in Dehradun recently in the first week of October 2019. Through this article the writer would like to attract the attention of Dr Harsh Vardhan Union Health Minister and the Uttarakhand Chief Minister so that tottering health administration is brought back to rails and those responsible for the lapses are made accountable.

A Tuberculosis patient from Uttarkashi District became critical because either he did not take proper medicine or was not given proper treatment at the primary health centre. On 29th September he started vomiting blood and was rushed to a hospital in Vikas Nagar in ambulance but the hospital could not help. He was then taken to Dehradun at ''Doon hospital'' which is part of Dehradun Government Medical College. He could not be admitted as the Emergency as well as Intensive Care Unit (ICU) were both over flowing with Dengue patients. He was then taken to Indresh hospital and Medical College which is a private hospital. Here also he did not find a bed as it was also full of Dengue patients. At this juncture his family informed me and I then contacted the Agriculture Minister of Uttarakhand who arranged his admission in Doon hospital in the emergency in the night. In the meanwhile he continued vomiting blood and the staff in Doon hospital told his family that he needs intensive care if his life is to be  saved. Considering the precarious conditions I then spoke with Max hospital where some preliminary treatment and X ray was done but when they knew about the cost of the treatment the family approached me for advice. At this juncture I contacted Mr. Vijay Dhasmana Chancellor of Jolly Grant Medical College established by Swami Ram and told him that the patient may die if not treated immediately and requested him to admit.  He was very positive and called back after 5 minutes and told me to send them to Jolly Grant hospital emergency and the patient was admitted in a special room as this hospital was also full of Dengue patients. 

The catch is the Ayushman Bharat Card was not accepted by any of the private hospitals in Dehradun including Jolly Grant Medical College. When I spoke with the hospital staff about it they told that as per the Uttarakhand government's guidelines they are not authorized to accept the card unless it is referred by a government hospital. 

The question is why the medical bureaucracy need to refer in emergency cases like this. The India system's complexity is due the British phobia that every Indian is to be monitored lest he may steal and this psychology transformed into bureaucratic red tapism. All empanelled hospital should be free to admit the patients for any disease which is admissible only then the targeted objectives of the scheme will be achieved.  The government could better use the medical bureaucracy in monitoring the effectiveness of the scheme.

 The larger question however is that this incident happened because the health and sanitary infrastructure had collapsed in Dehradun resulting in Dengue epidemics as hospitals are full of Dengue patients and many people have also died. This has happened due to the negligence of all concerned agencies and the chief culprit is Dehradun Municipal Corporation who are not collecting the garbage on regular basis and lower staff remain on strike on one pretext or the other and seniors donot bother. 

I have also seen during my tenure in Tripura that Doctors mistreating and private clinics fleecing patients 

It is hoped the concern authorities in the Central and State will take note of this as a positive feedback and revamp the health care system so that poor and needy do not have to rush from pillar to post. What is much more crucial is the need  to control the bourgeoning population as no amount of facility and infrastructure will be sufficient unless population is controlled effectively. The government must deprive of voting right to anyone who has more than two children and debar them from standing in election like in many states in Panchayat election .

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